IN CASE OF MEDICAL OR SURGICAL NECESSITY OR EMERGENCY, I HEREBY GIVE MY PERMISSION TO THE PHYSICIAN SELECTED BY THE YOUNG PEOPLE'S CHORUS OF NEW YORK CITY STAFF AND CHAPERONES TO PROVIDE WHATEVER MEDICAL OR SURGICAL TREATMENT IS NECESSARY.

THE HEALTH HISTORY IS CORRECT, AND MY CHILD HAS PERMISSION TO ENGAGE IN ALL PRESCRIBED ACTIVITIES EXCEPT AS NOTED BELOW: